Cervical Cancer—Patient Algorithm

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Cervical cancer is a type of cancer that starts in the cervix, which is the lower part of the uterus. Screening for cervical cancer is done with a Pap test to identify abnormal changes in the cells of your cervix caused by viruses such as the Human Papillomavirus (HPV). In a few women, these abnormal cells develop into cancer.

Cervical cancer screening can lead to early treatment, which can prevent the abnormal cells from developing into cancer, or can cure early cancer with simple treatment. The Canadian Task Force on Preventive Health Care (CTFPHC) updated its recommendations on cervical cancer screening to ensure that women receive the greatest benefit from screening while reducing inconvenience, discomfort and unnecessary testing.

Should you be screened for cervical cancer?

The figure below can help you make an informed decision about when to screen for cervical cancer with a Pap test.

For women who have received HPV vaccinations, we recommend the same screening schedule but talk to your health care provider further about HPV vaccination and cervical cancer risk.

Please note that these recommendations do not apply to women who have never been sexually active, have had a full hysterectomy for a benign (i.e. non-cancerous) disease, who have had a previous abnormal Pap test, and/or have a weakened immune system.

If you are…

Our recommendation

Explanation

Not sexually active

This guideline does not apply to you.

After you become sexually active, speak with your health care provider about when and how often you should be screened for cervical cancer with a pap test.

Sexually active and 24 years old or younger

We recommend not routinely screening.

Young women are very unlikely to have cervical cancer, but more likely to have abnormal Pap test results that can expose them to additional unnecessary tests.

Sexually active and 25–69 years old

We recommend routine screening every 3 years.

From age 25, the chance of getting cervical cancer increases. Benefits of screening begin to outweigh the likelihood of having an abnormal Pap test result that may require additional unnecessary tests.

Sexually active and 70 years old or older

We recommend stopping routine screening only if the last 3 Pap tests in the last 10 years were negative.

There appears to be no additional benefit of continuing screening if Pap test results have been continuously negative.

I am a woman between the ages of 25 and 65. Why should I be screened every 3 years?

Among women who do not screen, the lifetime risk of dying from cervical cancer is about 1 in 100

Among women who screen every 3 years, the lifetime risk of dying from cervical cancer is about 1 in 500

Among women who screen annually, the lifetime risk of dying from cervical cancer is about 1 in 588

After the age of 25, the likelihood of being diagnosed with cervical cancer increases dramatically. 86% of women who get cervical cancer are between the ages of 25 and 69. Screening with a Pap test improves a woman’s chances of survival from cervical cancer. However, screening more often than every 3 years may not add any additional benefits and may expose women to more frequent “false positive” or abnormal Pap test results. About 3% of women over the age of 30 will have an abnormal Pap test result, which may lead to additional unnecessary tests (see “What else should I know about cervical cancer screening?” below).

I am a woman 24 years of age or younger. Should I be screened for cervical cancer?

About 1% of women who get cervical cancer are 24 years of age or younger

Women 20 to 24 years of age have a less than 1 in 500 000 chance of dying from cervical cancer

Because there is such a small risk of being diagnosed with and dying from cervical cancer, young women are very unlikely to benefit from cervical cancer screening. Additionally, about 10% of young women have an abnormal Pap test result. This makes young women 24 years of age or younger more likely than older women to be exposed to additional testing that may be unnecessary (see “What else should I know about cervical cancer screening?” below).

What else should I know about cervical cancer screening?

Sometimes a Pap test shows abnormal cells in the cervix. An abnormal test result does not mean you have cervical cancer, but will need follow-up with either a repeat Pap test or additional follow-up tests such as colposcopy (examination of cervix with a magnifying instrument) and/or biopsies (removing a sample of cells with an instrument in minor surgery) to check under the microscope. Waiting for the outcome of an abnormal test result may cause anxiety and/or stress.

Be informed! Talk to your health care provider about when and how often you should be screened for cervical cancer.

Before each meeting, every member of the Canadian Task Force on Preventive Health Care (CTFPHC) and of the Evidence Review and Synthesis Centre (ERSC) completes a Declaration of Affiliations and Interests Form to report any potential conflicts of interest (e.g., financial, business or professional, intellectual). Disclosure is required for each new topic, and disclosures must be updated to reflect any changes that have occurred since an initial disclosure. Completed forms are kept on file, and outside experts who are asked to comment on the recommendations and documents prepared by the CTFPHC are also required to complete disclosure forms, which are kept on file. For more information, please refer to the CTFPHC’s Procedure Manual.